So this is it! My last reflection! I can’t believe it is all done and feels like the year just flew by. Emergency was a great rotation to end on as Rich is a very relaxed preceptor (not to say I did not learn a lot!).
Instead of a case presentation or journal club, I wrote up a drug information question on IV valproic acid for treating status epilepticus. You can read it here: DIquestion
All in all, it was a great rotation and I unfortunately had to deal with a situation where a physician got upset with me for looking at a leg wound on a patient with cellulitis. This physician did not feel comfortable with “pharmacists” doing physical exam and sparked quite the contreversy and the issue went all the way up to the pharmacy managers. However, I guess this is also good news in the sense that our prescence at VIHA is starting to get noticed!
Emerg: Week 1 and 2!
Posted on: July 8, 2010
This week I got to go to the cath lab after a patient came in with an ACS. It was really nice to watch the angioplasty and they had the patient to the hospital within 30 minutes of his symptoms! The cardiology resident explained where the catheter was going and it was really interesting to see it because I will probably never have that experience again Other procedures I got to see was procedural sedation for cardioversion, fracture and a patient who ended up going in cardiac arrest.
All in all, emergency is very different from my previous rotations as I have learned “let go” of trying to solve ALL the DRPs. Most of the time, patients are gone in less than a day. I generally do a medication reconciliation and deal with their chief complaint if it is drug related and antibiotics.
Another thing I have done a lot in this rotation, or more so than others is writing a lot of chart notes. Since the patients all have different MRPs it’s not as simple as tracking finding one or two doctors. The doctors are generally all over the hospital so I have written more notes in this rotation than any of my other rotations. I have to admit I’m still not very “quick” with them but I am getting better.
Emergency
Posted on: July 8, 2010
Objectives: RJH Residency Rotation Outline – ED
So I just realized I had no actually posted all my ER reflections! They were in my draft box for some reason! So my last two reflections are in posted today as well!
Poster Presentation Night
Posted on: May 22, 2010
On Wednesday, we travelled to Vancouver for the annual BC Residency Poster Presentation Night. During the afternoon, the evaluators came around to each our posters to ask questions. In the evening, we did a quick 5 minute Powerpoint presentation for pharmacists.
It was a long day but my poster turned out really well. I had some great discussions with renal pharmacists who showed up to the event.
Although, we did have some glitches and issues with the printing services department along the way. Everything worked out in the end. My poster is currently on display in the Renal Unit at RJH.
Here is a copy of my poster: HChui poster
I just finished off my last day of my “outpatient clinic” rotation. Overall, I learned a lot during the last few weeks.
Pain Clinic
- I did 4 full patient work ups. Some of the patients were very complicated but it was nice to have time to sit down and do a full work up without being pressed for time. The staff at the Pain Clinic were also very welcoming and appreciated having us around so it was a nice environment to work in. patient1 patient2 patient3
- Instead of doing a case presentation, I did an in-service for the staff. The topic I presented on was a new patch that is soon to be released by Purdue Pharmaceuticals. I did review some of the evidence but geared it more toward a non-pharmacy audience (which was a challenge because all the presentations I have done up to this point have been for pharmacists). I did not get a very good turn out unfortunately but I left some handouts for the staff and my email if they had any questions. Here is a copy of the presentation slides: bupherenorphinepatchslides
Anticoagulation Clinic
- I had a variety of different preceptors because my primary preceptor was away on vacation for part of the rotation. The first week I felt pretty uncomfortable because I felt like I had no idea what was going on. But once I got the process down and figured out how to organized the patients I slowly got the hang out it. I think I could handle covering it next year if they needed me to. I am also more comfortable with increasing and decreasing doses of warfarin, which I admit prior to this rotation I was not that skilled at.
- I also taught the Warfarin Classes twice a week on Tuesday and Thursdays. I really enjoyed the experience and most of the patients came out of the class saying they learned many things and they also had numerous questions.
- Lastly, I did photocopy some of my work ups and dosage adjustments which I’ve attached here: documentation
Pain clinic Journal Club
Posted on: April 15, 2010
Yesterday, I presented a JC at Pain Clinic rounds yesterday with Amrit Mann, a UBC pharmacy student, 4th year. We got good response from all the pain clinic staff. Here’s a copy: painclinicJChandout
I just finished week one of my pain clinic/anticoagulation clinic rotation. I’m spending the mornings in the Pain Clinic and the afternoons in the anticoagulation clinic. It’s a bit weird being in two different specialities at a time but so far it’s been working out.
I watched Donna doing two interviews with pain patients and then today I conducted one on my own. I was a little rusty but Donna helped me out. I’m in the process of writing up my assessment and recommendation to the family doctor. Most of the patients who come to the clinic have tried almost every pain medication out there and by the time they get to us, there are fewer and fewer options available. I’m starting to learn about the lidocaine infusion protocol they have started using in some patients.
I’m also a little flustered in the anticoagulation clinic because the first couple of days I wasn’t really sure of the process. But today, I counselled a patient who had a DVT on injecting dalteparin and on warfarin and transferred her warfarin prescription to her community pharmacy. Next week I’m hoping to do a full work up on a patient from start to end (admission to discharge).
Outpatient clinic rotation
Posted on: April 9, 2010
Objectives: Outpatient_Pain AnticoagulationApr2010
Nephrology rotation…wrap up
Posted on: April 3, 2010
The last two weeks of my renal rotation were busy. I got to meet most of the nephrologists and participated in rounds with a couple of them. Some of the patient work ups presented to be a challenge as many patients have no idea what they are taking or live in a care home so it was a matter of tracking down their MARs.
One thing I liked about the rotation was I able to easily follow up on interventions I made because patients returned to the renal unit three times a week. For example, I suggested stopping a PPI in a patient who really had no indication for the drug and I was able to follow up, in person, to see if the patient started having any issues with GERD or dyspepsia the next week.
One of my goals for the rotation was to learn about calcium and phosphate metabolism in renal patients and how to manage patients with pharmacotherapy. Most of the patients had some issues with their phosphate and PTH so I had a lot of practice in terms recommending changes to vitamin D analogues and phosphate binders. Of course by now, I’ve become pretty comfortable with anemia management so I recommended a lot of loading doses for IV iron!
I’ve attached copies my journal club and case presentation handouts below:
Journal club handout: JChandoutrenal
Case presentation handout: renalpresentationhandouts
Nephrology – Week 1
Posted on: March 12, 2010
So the renal unit it is a complete change of pace from ICU! I’ve worked up a few patients and in general they are pretty stable. The big issue with dialysis patients and their medications is compliance! You can actually tell if someone isn’t taking their TUMS because their phosphate levels go up. Dialysis patients are on an average of 15 medications and evidently med rec is a really important of a renal pharmacist’s job. I’ve found anywhere from 2 to 10 discrepancies so far per patient!
The other thing I’ve noticed (or already knew) is that there isn’t a lot of evidence for many of the medications given to dialysis patients. This makes recommending therapy difficult. For example, there is an HD patient who will require long term prednisone for 6-12 months and the question came up about whether a bisphosphonate is indicated in this situation. In a patient, with a CrCl of > 35 mL/min, a bisphosphonate plus vitamin D and calcium would be indicated if the patient was on steroids for greater than three months and a dose greater of equal to 5 mg of prednisone per day. There are absolutely no bisphosphonate studies done in dialysis patients and the “normal practice” is simply to give alendronate 70 mg q2weeks instead of weekly.
heatherchui
Heather Chui's E- Portfolio 